3 CLASSIFICATION OF ASPERGILLOSISInvasive aspergillosisAcute (<1 month course)Subacute/chronic necrotising (1-3 months)Airways/nasal exposure to airborne AspergillusChronic aspergillosis (>3 months)Chronic cavitary pulmonaryAspergilloma of lungChronic fibrosing pulmonaryChronic invasive sinusitisMaxillary (sinus) aspergillomaAllergicAllergic bronchopulmonary (ABPA)Extrinsic allergic (broncho)alveolitis (EAA)Asthma with fungal sensitisation (SAFS)Allergic Aspergillus sinusitis (eosinophilic fungal rhinosinusitis)Persistencewithout diseasecolonisation ofthe airways or nose/sinusesExposure to individual Aspergillus spores or conidia is almost constant. If eradicated immediately, as is usual in normal people, no disease results. If colonisation occurs, it may be short or long term. The pattern of disease is mostly determined by the host group (see next slide), with probably a component of the inoculum size contributing to invasive disease.

4 CLASSIFICATION OF ASPERGILLOSISInvasive aspergillosisAcute (<1 month course)Subacute/chronic necrotising (1-3 months)Airways/nasal exposure to airborne AspergillusChronic aspergillosis (>3 months)Chronic cavitary pulmonaryAspergilloma of lungChronic fibrosing pulmonaryChronic invasive sinusitisMaxillary (sinus) aspergillomaPersistence without disease - colonisation of the airways or nose/sinusesExposure to individual Aspergillus spores or conidia is almost constant. If eradicated immediately, as is usual in normal people, no disease results. If colonisation occurs, it may be short or long term. The pattern of disease is mostly determined by the host group (see slide 8), with probably a component of the inoculum size contributing to invasive disease.Acute and subacute disease is usually associated with immunocompromised patients eg AIDS, chemotherapy, transplant etc. and these will be discussed first.AllergicAllergic bronchopulmonary (ABPA)Extrinsic allergic (broncho)alveolitis (EAA)Asthma with fungal sensitisationAllergic Aspergillus sinusitis (eosinophilic fungal rhinosinusitis)

9 Criteria for Halo Sign n gg“Perimeter of ground-glass opacity surrounding a nodular lesion”Identified early in angio-invasive aspergillosisDifferentiate from nodular lesions with unsharp margination that lack a perimeter of ground-glassnggThe Halo Sign is a perimeter of ground-glass opacity on computed tomography that surrounds a nodular lesion.It is seen in angioinvasive aspergillosis.Ground-glass opacity on CT refers to an intermediate density between completely aerated lung and solid lung opacification such that bacground pulmonary vessels can be seen through it.gg = ground-glass halon = nodular lesionGreene et al, ECCMID 2003

19 BSMM proposed standards of careAll bronchoscopy fluids from patients suspected of infection should be examined microscopically for hyphae and cultured on specialised media.All clinical isolates of Aspergillus should be identified to species levelDenning, Barnes and Kibbler. Lancet Infect Dis 2003;3:230.

23 CLASSIFICATION OF ASPERGILLOSISInvasive aspergillosisAcute (<1 month course)Subacute/chronic necrotising (1-3 months)Airways/nasal exposure to airborne AspergillusChronic aspergillosis (>3 months)Chronic cavitary pulmonaryAspergilloma of lungChronic fibrosing pulmonaryChronic invasive sinusitisMaxillary (sinus) aspergillomaPersistence without disease - colonisation of the airways or nose/sinusesExposure to individual Aspergillus spores or conidia is almost constant. If eradicated immediately, as is usual in normal people, no disease results. If colonisation occurs, it may be short or long term. The pattern of disease is mostly determined by the host group (see next slide), with probably a component of the inoculum size contributing to invasive disease.However chronic disease if usually seen in patients with apparently normal immune systems.AllergicAllergic bronchopulmonary (ABPA)Extrinsic allergic (broncho)alveolitis (EAA)Asthma with fungal sensitisationAllergic Aspergillus sinusitis (eosinophilic fungal rhinosinusitis)